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Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study
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Correction: Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study - February 01, 2020
http://orcid.org/0000-0002-1286-0038Xiaoxuan Liu1,2,3,
http://orcid.org/0000-0002-2186-1446Aditya Uday Kale2,
Nicholas Capewell1,
Nicholas Talbot1,
Sumiya Ahmed1,
Pearse A Keane3,4,
Susan Mollan1,5,
Antonio Belli1,6,7,
Richard J Blanch1,8,
Tonny Veenith1,7,
Alastair K Denniston1,2,3,4,5
1Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
2Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
3Health Data Research UK, London, United Kingdom
4NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
5Centre for Rare Diseases, Institute of Translational Medicine, Birmingham, UK
6Institute of Inflammation and Ageing, University of Birmingham, College of Medical and Dental Sciences, Birmingham, UK
7Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
8Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
Correspondence to Professor Alastair K Denniston; a.denniston{at}bham.ac.uk
Objective This study aims to evaluate the feasibility of retinal imaging in critical care using a novel mobile optical coherence tomography (OCT) device. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is an OCT unit with a boom arm, enabling ocular OCT assessment in less mobile patients.
Design We undertook an evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients.
Setting This study was conducted in the critical care unit of a large tertiary referral unit in the United Kingdom.
Participants 13 systemically unwell patients admitted to the critical care unit were purposively sampled to enable evaluation in patients with a range of clinical states.
Outcome measures The primary outcome was the feasibility of acquiring clinically interpretable OCT scans on a consecutive series of patients. The standardised scanning protocol included macula-focused OCT, OCT optic nerve head (ONH), OCT angiography (OCTA) of the macula and ONH OCTA.
Results OCT images from 13 patients were attempted. The success rates of each scan type are 84% for OCT macula, 76% for OCT ONH, 56% for OCTA macula and 36% for OCTA ONH. The overall mean success rate of scans per patient was 64% (95% CI 46% to 81%). Clinicians reported clinical value in 100% scans which were successfully obtained, including both ruling in and ruling out relevant ocular complications such as corneal thinning, macular oedema and optic disc swelling. The most common causes of failure to achieve clinically interpretable scans were inadequately sustained OCT alignment in delirious patients and a compromised ocular surface due to corneal exposure.
Conclusions This prospective evaluation indicates the feasibility and potential clinical value of the SPECTRALIS FLEX OCT system on the critical care unit. Portable OCT systems have the potential to bring instrument-based ophthalmic assessment to critically ill patients, enabling detection and micron-level monitoring of ocular complications.
adult intensive & critical care
optical coherence tomography angiography
This is the first study demonstrating the capabilities of the FLEX optical coherence tomography (OCT) device in critical care, conducted in one of the largest critical care centres in Europe.
This feasibility study uses both qualitative and quantitative data to first report image success, and second to provide information regarding image optimisation techniques for both OCT and OCT angiography.
In addition to scan success and image optimisation techniques, we have included a case series investigating the strengths and limitations of using this novel OCT device in a range of patients with varied clinical states, providing an insight into the potential value of this device in critical care and ward-based patients.
A key limitation of our study is the cohort size of 13 participants, and although this limits statistical power this cohort provides a valuable insight into the value of mobile OCT devices.
Optical coherence tomography (OCT) is a non-invasive, light-based imaging technique which enables in vivo, cross-sectional imaging of structures, including human tissues, at high resolution.1 Its medical application is primarily in retinal imaging where current OCT devices can now accurately resolve the individual retinal layers and provide automated measures of retinal thickness estimated to the nearest micron. Additionally, eye-tracking overlays enable consecutive images to be digitally subtracted allowing detection of changes of even a few microns. It is thus an extremely powerful tool both for diagnosis and monitoring of diseases related to the retina, the optic nerve and other visualisable structures within the eye. A major advance of the last couple of years has been OCT angiography (OCTA), in which the detection of the phase shift of erythrocytes travelling through the retinal capillaries enables a detailed map of the retinal capillaries, and for the first time a real-time non-invasive map of retinal ischaemia.2
The use of ophthalmic OCT and OCTA to detect both physiological and pathological changes could be highly valuable in a critical care setting. One example of its potential utility is mapping the retinal vessels for non-invasive estimations of the microcirculation. It has been shown that retinal blood flow, as measured by fluorescein angiography, exhibits prolonged retinal arterial filling time in patients with lower cardiac index.3 The same study found microvascular abnormalities such as retinal microaneurysms and retinal haemorrhages (findings common to diabetes and hypertension) in patients with severe sepsis. While fluorescein angiography has its uses, it carries significant risks such as anaphylaxis. It is also not suitable for patients with renal impairment. OCTA on the other hand is non-invasive and fast. This makes it ideal for monitoring the physiological status of a patient with serial scans. Another example of where OCT is valuable is its ability to measure changes in the retinal nerve fibre layer (RNFL). There are a number of neurological conditions in which RNFL changes have been detected, such as RNFL thinning in chronic traumatic encephalopathy following traumatic brain injury and RNFL thickening seen in idiopathic intracranial hypertension.4–6 OCT-derived measurements could provide surrogate markers of systemic disease which can guide treatment and give valuable prognostic information. So far, this has not been possible due to limitations in the design of current hardware. Most commercially available OCT platforms are static, table-top-mounted machines which scan the patient in an upright, seated position. The patient places their head on a headrest in front of the OCT lens and is asked to fixate as instructed by the operator. This conventional set-up is most suited for patients who are alert, compliant and comfortable at a normal seated height and with a good degree of neck flexion. Topical mydriatics are often given to dilate the pupils for a wider aperture through which the image can be acquired; however, good-quality OCT scans can be acquired in undilated patients.7 The only other commercially available alternative to the standard table-mounted OCT system is a handheld OCT (Envisu C2300, Leica Microsystems, Wetzlar, Germany); however, handheld devices are lacking in stability and are more sensitive to motion artefact and alignment issues.8 9
The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is a newly available modified OCT machine designed for use in a variety of clinical settings. In addition to being trolley-based (similar to a portable X-ray machine), it has a boom arm, designed to enable ocular OCT assessment in less mobile patients. The use of ocular OCT imaging as a diagnostic or monitoring tool for systemic conditions is in its infancy, and there are no studies to our knowledge evaluating its role in a critical care setting. This study evaluates the feasibility of using the Heidelberg SPECTRALIS FLEX module in systemically unwell patients in a ward environment.
Study design and setting
This was a cross-sectional evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking clinically useful ocular OCT images in unconscious and critically ill patients in a major critical care unit at University Hospitals Birmingham NHS Foundation Trust. The critical care unit is a tertiary referral unit with 68 level-3 equivalent beds and is one of the largest critical care units in Europe.
This study was carried out from January to August 2018.
Outcome measures
The primary outcome of this evaluation was the feasibility of acquiring clinically interpretable OCT scans on a consecutive series of patients, matched against a standard protocol. Acquired scans were reviewed by two ophthalmology specialists experienced in interpreting retinal OCT images. This was reported as percentage of patients for whom clinically interpretable scans were obtained for each modality and percentage of patients for whom the complete scan protocol was obtained. A 100% success rate was defined as all scans successful in both eyes.
Scan protocol
The standard scanning protocol included four scans: standard macula-focused OCT, OCT optic nerve head (ONH), OCTA of the macula and OCTA of the ONH. This protocol was attempted for both eyes of each patient. The OCT scans used were the Heidelberg Engineering preset 'Fast Macula' and ONH (RNFL) OCT scans. The Fast Macula scan is composed of 25 B scans at automatic real-time (ART) setting 9 (9 images averaged) over an area of 5.7 mm2. The ONH scan is composed of a single B scan ring around the ONH, with an ART setting of 100. The OCTA scans were composed of 512 B scans, totalling an area of 2.8 mm2, with an ART setting of 5.
Statistical analysis
Descriptive statistics are provided with feasibility and clinical value being reported as percentages; tests of statistical significance are not relevant to this study.
OCT assessment with the SPECTRALIS FLEX
The optical system attached to the Heidelberg SPECTRALIS FLEX module is the same as the table-top platform, equipped with the 'OCT2 system' to provide both OCT and OCTA. The major difference to the table-top system is that the acquisition lens is mounted on a flexible 'boom' arm which can be extended away from the main body of the module to approximately 100 cm (figure 1). The flexible arm can be configured and tightened at different pivotal points along its length, thereby accommodating patients in a variety of different positions during scanning. The main body of the FLEX is mounted on wheels enabling portability of the module. The FLEX system is usually mains-powered but can operate for approximately 20 min on battery reserve when needed.
The Heidelberg SPECTRALIS FLEX module positioning as demonstrated by authors (AUK and NC). CPU, central processing unit; OCT, optical coherence tomography.
We found several adjustments relating to position of the machine and preparation of the patient which significantly improve ease of image acquisition as described in the following two sections. Operators were already proficient in operating table-top OCT scanners; however, training over approximately 2 hours was conducted to allow the staff to familiarise themselves with operation and manoeuvring of the FLEX module.
Manoeuvrability and positioning
The device can be positioned comfortably at the bedside, and its extendable arm gives sufficient reach over a hospital bed (including critical care beds). Our approach to positioning the device and its operators around the bed space is shown in figure 1. Operator 1 is positioned over the patient, holding the OCT camera piece in front of the patient to make small adjustments to alignment during acquisition if required. Operator 2 operates the desktop interface to lock and acquire the image and change settings in between scans using the keyboard. In an unconscious patient, having an additional operator standing behind the patient's head to hold it in position and to lift the eyelid is advantageous.
Preparation of the patient
Pupillary dilation was undertaken unless clinically contraindicated. We found that pupillary dilation had a much greater impact on quality of scans than with conventional OCT. The larger aperture partly compensates for problems with maintaining optical alignment which may arise from several issues including lack of forehead and chin support, systemically unwell patients losing fixation due to fatigue, or unconscious/delirious patients not fixating at all. Ample verbal prompting and reassurance were given during longer acquisition modalities (notably OCTA) to help the patient maintain focus. Ocular surface lubricants were given between scan acquisitions to improve the ocular surface, a common issue in unconscious patients which can impact the quality of scans.
Patient and public involvement
As this was a pilot study evaluating novel technology, patients and the public were not involved in the design or conduct of this study.
Technical feasibility
Feasibility was assessed against the completion of the full protocol of structural and vascular assessment of the retina and optic nerve (comprising OCT macula, OCT ONH, OCTA macula and OCTA ONH). OCT images from 13 patients were attempted, with at least one clinically interpretable OCT being achieved in 92% (12 of 13 patients). None of the included patients had known existing ocular pathology. The success rate of each scan type from the scan protocol are 84% successful for OCT macula, 76% for OCT ONH, 56% for OCTA macula and 36% for OCTA ONH. Completion of the full protocol was possible in 31% (4 of 13 patients). The mean scan protocol success rate per patient was 64% (95% CI 46% to 81%). Table 1 summarises the conditions under which scans were obtained.
Summary of scan acquisition in all cases, success rates for completing the whole protocol and problems encountered
Clinical value
Clinical value was reported in 100% cases where interpretable scans were achieved. In these scans the clinical value was reported as 'ruling out' serious complications of the underlying systemic disease; in the remainder the clinical value was either diagnostic or the ability to quantitatively monitor retinal or ONH status.
Case examples
The following cases highlight the clinical value in four different contexts and demonstrate the potential clinical value of the OCT modalities available.
Case 1: postoperative oesophagectomy
Patient 1, who was admitted for two-stage oesophagectomy for an oesophageal adenocarcinoma, was scanned at day 1 postoperatively, while making a good recovery. At the time he was able to sit up in bed, was alert, compliant and able to maintain good fixation, enabling successful acquisition of the full scan protocol (figure 2). Serious complications including retinal ischaemia and retinal vascular occlusive disease were ruled out based on the scans.
Case 1. The above composite image includes OCT and OCTA scans showing the retinal layers and retinal vasculature. OCT macula infrared image (A) and cross-sectional view (B). Image B is a cross-section of the macula indicated by the white arrows in images A–C and F. The bracketed area of image B indicates the retinal layers from the inner limiting membrane to the retinal pigment epithelium, below which is the choroid. Scans A and B are most commonly obtained in clinical practice and can be used to exclude retinal disease such as age-related macular degeneration. OCT optic nerve head infrared image (C) and cross-sectional scan (D). OCTA macula en face view (E) and cross-sectional view (F). The circular area in image E marked with an orange border is the foveal avascular zone (a round, capillary free zone) corresponding to the area of the macula. Hyper-reflective areas indicate red blood cell movement (ie, blood flow), with hyporeflective areas indicating a lack of red blood cell movement. Cross-sectional images F and H show blood flow indicated by yellow areas of the OCTA scan optic nerve head en face view (G) and cross-sectional view (H). The optic nerve head in image C corresponds to the hyporeflective area in image G. The optic nerve is highlighted by the green border in images C, G and H. OCT, optical coherence tomography; OCTA, OCT angiography.
Case 2: sepsis
Patient 2 was admitted due to accidental paracetamol overdose with secondary renal failure, pulmonary failure and sepsis. At the time of scanning the patient was sedated and intubated. The patient was scanned in a semirecumbent position in bed, with eyelids held open by one of the scan operators (figure 3). Additional technical challenges were (1) the poor quality of the ocular surface due to poor lid closure and inadequate lubrication resulting in corneal epitheliopathy (exposure keratopathy), and (2) patient movement resulting in an alignment artefact in the reconstructed OCTA rendition of the capillary plexi.
Case 2. Right eye OCT macula infrared (A) and cross-sectional view (B). OCTA macula en face view (C) and cross-sectional view (D). Poor ocular surface can be seen in the infrared image (A), and an alignment artefact arising from patient movement can be seen as a dark stripe on the OCTAs (C, D). OCT, optical coherence tomography; OCTA, OCT angiography.
Case 3: traumatic brain injury
Patient 3 was admitted following polytrauma and traumatic brain injury. Scans were acquired while the patient was intubated and sedated. The left eye (scanned eye) was fixed and dilated secondary to traumatic brain injury (figure 4). Optic nerve swelling, retinal detachment and retinal haemorrhage were successfully ruled out in this eye using the OCT scan. The right eye was not dilated using topical mydriatics so as not to interfere with the patient's neurological observations; scan quality through the undilated pupil was poor, with acquisition of OCTA not being possible; therefore, imaging in this eye was abandoned.
Case 3. OCT macula infrared image (A) and cross-sectional scan (B). OCT optic nerve head infrared image (C) and cross-sectional scan (D). OCTA macula en face view (E) and cross-sectional view (F). OCTA optic nerve head en face view (G) and cross-sectional view (H). OCT, optical coherence tomography; OCTA, OCT angiography. Green lines in images 4A and 4C indicate areas where corresponding cross-sectional images were obtained.
Case 4: toxic epidermal necrolysis
Patient 4 was admitted with toxic epidermal necrolysis (TEN) with 60% cutaneous involvement and corneal erosions. This patient was scanned in a supine position. The patient was being weaned off sedative medication and was agitated and delirious, with a Glasgow Coma Scale score of 10 out of 15. A macula-focused OCT was acquired; however, further imaging was abandoned due to quality of scans. An additional scan—anterior segment (AS) OCT—was performed so as to evaluate the cornea since the primary clinical concern in cases of TEN is of corneal and ocular surface disease. A good-quality, single-section AS-OCT was obtained, and serious corneal thinning was successfully ruled out. The major technical challenges here were the poor ocular surface related to her disease and the low level of patient compliance and fixation (figure 5).
Case 4. OCT macula (A, B) could only be acquired using a single line scan and the quality was poor. A single line macula was obtained, but the rest of the protocol was abandoned. A single line OCT scan of the anterior segment was obtained to assess integrity of the cornea (C). Green arrows shown in these images represent the area show in the corresponding cross-sectional views.
In this prospective evaluation, we demonstrated the feasibility of using the SPECTRALIS FLEX module for undertaking clinically interpretable ocular OCT images in unconscious and critically ill patients in a critical care unit. The primary outcome of this evaluation was the feasibility of acquiring clinically interpretable OCT. Our experience is that OCT macula was possible in 84% and OCT ONH in 76% of our cohort. OCTA was more challenging, with success rates of 56% for macula and 36% for ONH.
OCT is already recognised as a vital part of the clinical assessment for most retinal and optic nerve diseases, providing a permanent objective record and quantitative assessment of physiological and pathological status. Its clinical value is not therefore in doubt, but it is not yet clear whether this can be translated into the critical care environment.
The SPECTRALIS FLEX is a novel device. The only report of its use is in an intra-operative setting for acquiring aqueous angiographic images during phacoemulsification.10 Handheld OCT devices are available, and their use has been described in a range of patients including in children,11 12 in sedated patients13 and in the intraoperative environment.8 The only commercially available handheld OCT device is the Envisu C2300 (Leica Microsystems). This compact device weighs only 1.6 kg and is connected to a desktop system on a mobile cart via a 2 m cable. It can acquire OCT images but does not have OCTA capabilities. In terms of stability and the avoidance of movement artefact, the SPECTRALIS FLEX provides better stability, since operator movement is minimal. However, this does not compensate for patient movement (ie, in the delirious patient) as seen in case 4, resulting in the typical misalignment.
The purpose of this evaluation was to provide a 'real-world' assessment of the feasibility of undertaking OCT using the FLEX system. The completion of the whole protocol was only possible in 31% of patients, which reflects the challenges that need to be overcome in the critical care environment, compared with an outpatient setting. Several reasons for scan failure are common to both environments. They include inability to maintain alignment (commonly acute confusion in critical care; dementia/learning difficulties; nystagmus and poor concentration in clinic); ocular surface disorders (commonly exposure keratopathy in critical care; any corneal pathology in clinic); media opacity (rare cause of failure in critical care; common cause in clinic due to, for example, cataracts); and extreme refractive errors. There are challenges associated with the SPECTRALIS FLEX module even among those who are experienced in using the table-top OCT systems. Our extensive experience has enabled us to refine our technical approach to improve capture, and guidance to help other users is provided as part of our protocol in the Methods section of this manuscript.
Key limitations of this study include first our small sample size of 13 patients, which limits the generalisability of the results; however, even with this small number, we are able to provide proof-of-concept as to the value of the FLEX module in a range of clinical conditions. Second, as a new technique, there may have been a significant 'learning effect' as OCT operators had to learn to overcome the challenges of moving from a stable table-top device in clinic to using the mobile FLEX unit on systemically unwell patients on a critical care unit. It is worth noting however that there was no general trend in the success rate of scans over time. Lastly, scan success was partly dependent on the patient's clinical state, and patient fatigue might reduce the success of scans attempted towards the end of our protocol. This may explain the lower success rate of OCTA ONH scans (which are relatively more demanding and time-consuming); standard OCT scans are unlikely to be affected as these are fast and less demanding for patients.
In our evaluation we found that clinicians reported clinical value in all cases where scans were possible, including both 'ruling-in' and 'ruling-out' relevant ocular complications. These may be sight-threatening complications such as corneal thinning in TEN or severe exposure keratopathy or macular oedema in diabetic eye disease. Alternatively, they may reflect life-threatening central nervous system (CNS) or systemic pathology, such as retinal microvascular changes or optic disc swelling in papilloedema. Although not tested with the SPECTRALIS FLEX module, standard table-top OCT and OCTA have been used in a range of relevant conditions, including raised intracranial pressure, neurodegenerative diseases and dementia.14–17 Additionally, the retinal vasculature exhibits autoregulation to systemic insults such as hypoxia and has demonstrated quantifiable reductions in vessel density during hypoxic provocation.18 19 Further work should aim to test the reliability and clinical utility of the FLEX module and compare this with both conventional table-top devices and handheld OCT systems. Further analysis of these devices should be undertaken in the critical care setting with a longitudinal follow-up to visualise retinal changes in patients with a range of clinical conditions.
We have evaluated the feasibility of using a novel, mobile OCT system to obtain retinal scans in unconscious and critically ill patients. Portable OCT systems have the potential to bring objective instrument-based ophthalmic assessment to the bedside, enabling detection and micron-level monitoring of ocular complications which may impact on vision or potentially serve as indicators of systemic health. This prospective evaluation indicates OCT and OCTA are feasible on the critical care unit, providing a promising foundation for the development of a new tool for improved clinical assessment and potential pathophysiological discovery in these patients.
We are grateful to Ali Tafreshi, Christopher Mody and Krysten Williams and the team at Heidelberg Engineering for their expertise and for providing the Heidelberg SPECTRALIS FLEX module for this study.
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XL and AUK are joint first authors.
Contributors AKD, PAK, TV, AB, SM and RJB conceived the study. XL, AUK, NC, SA and NT undertook data collection. XL, AUK, RJB and AKD undertook data analysis. AKD, TV and RJB supervised this study. All authors participated in drafting and review of the manuscript.
Funding XL, PAK and AKD receive a proportion of their funding from the Wellcome Trust, through a Health Improvement Challenge grant (200141/Z/15/Z). AKD and PAK receive a proportion of their funding from the Department of Health's NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology. TV, NT and AB receive a proportion of their funding from Queen Elizabeth Hospital Birmingham Charities.
Ethics approval Approval was granted by University Hospitals Birmingham NHS Foundation Trust for this prospective evaluation as a service evaluation, the purpose being to establish feasibility of introducing the standard of care for ophthalmic assessment using OCT to the local critical care unit.
Data availability statement Data are available upon reasonable request.
Correction: Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study
British Medical Journal Publishing Group
BMJ Open 2020; 10 - Published Online First: 04 Feb 2020. doi: 10.1136/bmjopen-2019-030882corr1


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2020: For new year and a new decade, here are 10 guiding principles of Imam Sultan Mahomed Shah, His Highness the Aga Khan, for a happy, rich and meaningful life in the years ahead
His Highness the Aga Khan: 2019 stories behind the photos
The historic visit of Mawlana Sultan Mahomed Shah, His Highness the Aga Khan, to Iran in 1951: Glimpses from a very rare Ismaili souvenir
A brief note on Kamarbai Ramji's 100th birthday celebration, and 5 rare photos from her family of Mawlana Hazar Imam, His Highness the Aga Khan
Exclusive: Photos of Prince Amyn Aga Khan's 1968 visits to Arusha and Egerton College
2 beautiful photos from 1957 of a blessed day in the lives of Sadruddin and Sakerkhanu Velji: Mawlana Hazar Imam, His Highness the Aga Khan, performs their marriage
A depiction of Mawlana Hazar Imam, His Highness the Aga Khan, at a Canadian Museum, and birthday messages from Canadian Ismaili leadership and Prime Minister
The Salgirah of Mawlana Hazar Imam, His Highness the Aga Khan, and his unbounded love for his spiritual children
A thorough and profound explanation of the Ginan Eji Dhan Dhan Aajano recited for the auspicious birthday of Mawlana Hazar Imam, His Highness the Aga Khan
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1960 and 2019 in the life of His Highness the Aga Khan: Honour by Portugal in Goa; and an inspirational wish in the City of Porto
Watch video: His Highness the Aga Khan at White House Conference on Culture and Diplomacy hosted by US President Bill Clinton and First Lady Hillary Clinton
Reports and Tweets: His Highness the Aga Khan at the 2019 Paris Peace Forum
Text and Audio: The Prophet Muhammad (s.a.s.) by His Highness the Aga Khan
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His Highness the Aga Khan III: A brilliant account of a reporter's face to face meeting with the 48th Ismaili Imam at the London Ritz
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Photos and Report: Asia Society Texas Center Honors Princess Zahra Aga Khan with annual Huffington Award
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Official Royal Family video and photos: His Highness the Aga Khan welcomes Duke and Duchess of Cambridge to Aga Khan Centre ahead of their tour of Pakistan
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Anver Versi, editor-in-chief of New African, interviews His Highness the Aga Khan – "A man for all seasons"
His Highness the Aga Khan in Tatarstan: Themes from his speech in Kazan; a superb gallery of photos; and 5 high quality videos of the visit
Video and Photos: Mawlana Hazar Imam arrives in Kazan – As it happens, a day by day coverage of his visit to Tatarstan for the Aga Khan Award for Architecture
Mawlana Hazar Imam is expected to arrive in Kazan, Tatarstan on September 11, for 14th Cycle of Aga Khan Award for Architecture
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A must watch presentation: Prince Hussain Aga Khan's clarion call for the preservation of environment and conservation of biodiversity
His Highness the Aga Khan embodies the ecumenical spirit that links the 3 great monotheistic religions
The Living Imam Mawlana Shah Karim al Hussaini, His Highness the Aga Khan, and the Nur (Light) of Imamat
The munajat Ya Ali Khuba Mijalas: A traditional ginan recited on the occasion of His Highness the Aga Khan's ascension to the throne of Imamat
His Highness the Aga Khan and the bubonic plague of 1897: How the young 48th Ismaili Imam's actions saved countless lives
Glimpses from past and present: The Aga Khans and Queens Victoria and Elizabeth II
In memory of Prince Aly Khan and Prince Sadruddin: Two brothers who passed away on same day 43 years apart
In 1966, His Highness the Aga Khan spoke brilliantly to African nations on seeking out areas of opportunity from new developments in computers and space
Exclusive: Rare photos of Imam Sultan Mahomed Shah and Mawlana Shah Karim from Jan Karmali Collection
Princess Yasmin Aga Khan speaks to the Globe and Mail about her mother and Alzheimer's
Thematic presentation of remarks made by Mawlana Hazar Imam and Portugal's President at the 1st Aga Khan Music Awards Ceremony at Gulbenkian
Comprehensive coverage of Mawlana Hazar Imam's visit to Portugal for the inaugural edition of the Aga Khan Music Awards totaling US$ 500,000 in prizes
Prince Hussain at 'Fragile Beauty' Exhibition in Nairobi; Prince Rahim at Fred Hutchinson Cancer Research Centre in Seattle; and Princess Zahra at launch of hospital expansion in Dar es Salaam
Selected sayings of Hazrat Ali, and His Highness the Aga Khan on his ancestor
"My Beloved Mother" – Lady Ali Shah through the voice of her son, Imam Sultan Mahomed Shah, Aga Khan III
Photos of Mawlana Hazar Imam, His Highness the Aga Khan, from a rare Ismaili magazine
The seal of Aga Khan University and convocation regalia of His Highness the Aga Khan
Historical Diamond Jubilee message from Imam Sultan Mahomed Shah to Ismaili youth: "The body is the temple of God for it carries the soul"
Barakah looks back at important 2018 stories of Mawlana Hazar Imam and members of his family that we did not publish during the year
Mawlana Hazar Imam's view of the world: More gems from his speeches
In historic visit to Islamic City of Marawi in Philippines, His Highness the Aga Khan vehemently rejected notion that modern education diminishes sharpness and deepness of our faith
His Highness the Aga Khan, Mawlana Hazar Imam, impressed scientists during his visit to Los Alamos Lab in 1959
Prince Rahim Aga Khan: Pluralism Harnesses Human Creativity and Kindles the Very Spirit of the Knowledge Society
The Aga Khan on the importance of education: The story of his Czech coach
Flashback 1978: Mawlana Hazar Imam's historic first visit to Canada included a cake cutting ceremony to celebrate his 42nd birthday
The Ismaili community's dynamic 48th Imam: A very brief portrait of His Highness the Aga Khan, Mawlana Sultan Mahomed Shah
"Mawla fulfilled my wish" – a six year old girl's loving story from the Diamond Jubilee of His Highness the Aga Khan III
Expressions for the Silver, Golden & Diamond Jubilees (and beyond) of our Beloved Imam Mawlana Shah Karim al Hussaini Aga Khan
India's Aga Khan Council President shares 3 personal stories and lessons he learned from gracious moments with Mawlana Hazar Imam during Diamond Jubilee visit
Joyful photos from His Highness the Aga Khan's Diamond Jubilee celebrations in Lisbon through the lens of Muslim Harji
Portugal President's surprise Darbar visit in Lisbon: A highpoint during Mawlana Hazar Imam's Diamond Jubilee; includes video clip
'A diamond is forever': In honour of His Highness the Aga Khan, Portugal Postal Service releases a unique souvenir sheet embedded with a 1.24mm genuine diamond – a family keepsake for generations to come
50+ magnificent photos of His Highness the Aga Khan with the President of Portugal at Belem Palace, National Palace of Queluz, and Palacete Henrique de Mendonça
A poetic piece on the grand finale of Mawlana Hazar Imam's Diamond Jubilee
Mawlana Hazar Imam's Diamond Jubilee: Memories of a modern day pilgrimage to Lisbon
Exclusive: The conclusion of a stirring account of Mawlana Hazar Imam's Darbar in Lisbon on July 11, 2018 – the "highest point" of his Diamond Jubilee
Exclusive: An inspiring and moving account of Mawlana Hazar Imam's Darbar in Lisbon on July 11, 2018 – the "highest point" of his Diamond Jubilee
The Aga Khan's Diamond Jubilee in Lisbon: Prince Hussain's little exhibition of animal photos is captivating
The many facets of His Highness the Aga Khan's leadership
The Aga Khan in UK and France: A thorough and comprehensive coverage of his Diamond Jubilee visit
The Talks, Titles, Treaties and Walks of the Aga Khan IV: Glimpses of his "Extra-ordinariness"
"And Diverse are their Hues" — A description of the Fatimid gift presented to Mawlana Hazar Imam during his USA Visit
The Aga Khan in Ottawa and Western Canada: A thorough and comprehensive coverage of his Diamond Jubilee visit
Exclusive: An inspiring and moving account of Mawlana Hazar Imam's Diamond Jubilee Darbar in Nairobi
Barakah logo and meaning
Barakah published 64 posts in 2019. Below we provide links to 16 interesting, thoughtful and inspiring pieces. Please click on link or photo to see the corresponding article in full.
A VISIT TO A LAB IN CALIFORNIA
A FASCINATING SPEECH IN THE PHILIPPINES
A BEAUTIFUL REGALIA
THE FIRST MUSIC AWARDS
PRINCES AND PRINCESSES IN ACTION
REMEMBERING TWO PRINCES
PASSION FOR PLURALISM
A CONVOCATION AND TRIBUTE IN RHODE ISLAND
FIRST VISIT TO TATARSTAN
NEW AFRICAN INTERVIEW
WEDDING IN GENEVA
AN HONOUR IN TEXAS
A UNIQUE PHOTO EXHIBITION
HONOURS FROM PORTUGAL ON TWO CONTINENTS
Date posted: December 30, 2019.
Before departing this website please take a moment to visit Barakah's Table of Contents for links to more than 190 pieces dedicated to Mawlana Hazar Imam, his family and the Ismaili Imamat.
Please join/like Barakah at http://www.facebook.com/1000fold and also follow us at http://twitter.com/simerg.
This website, Barakah, is a special project by http://www.Simerg.com and is dedicated to the textual and visual celebration of His Highness the Aga Khan and members of his family, as well as the Ismaili Imamat.
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Barakah, Family, His Highness the Aga Khan, Honours, News, Themes, Tribute
Barakah, His Highness the Aga Khan
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Indeed we all reflect back on what we did, achieved or not, improvise on our mistakes, do the best we can and leave the rest to ALLAH. Thanks for always articles. A HAPPY NEW YEAR TO ALL OF YOU AND PRAY 2020 WILL BE A BETTER YEAR FOR ALL HIS CREATION.
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text:
Q: Interactive reminder options not visible in iOS I have implemented interactive reminders for local notifications. But those interactive options are visible only when device is unlocked and user pulled down the reminders just after receiving. The first image show just after receiving local notification.

If you swipe it left or right nothing happen. But if you pull down, then you can see the two interactive options. Just like in the second image.

(Q1.) Actually, my first question is why it just show only two options while I have declared three interactive options?
Below is my related code for that.
UIMutableUserNotificationCategory *notificationCategory = [[UIMutableUserNotificationCategory alloc] init];
notificationCategory.identifier = mutableUserNotificationCategoryId;
[notificationCategory setActions:@[notificationAction1, notificationAction2, notificationAction3] forContext:UIUserNotificationActionContextDefault];
[notificationCategory setActions:@[notificationAction1, notificationAction2, notificationAction3] forContext:UIUserNotificationActionContextMinimal];

NSSet *categories = [NSSet setWithObjects:notificationCategory, nil];

UIUserNotificationType types = (UIUserNotificationTypeSound | UIUserNotificationTypeAlert);
UIUserNotificationSettings *settings = [UIUserNotificationSettings settingsForTypes:types categories:categories];
[application registerUserNotificationSettings:settings];

(Q2.) My second question is, why we can't see interactive options when user swipe the notification in any other stage. (Ex. notification shows under notification center) Please see my next images that I've uploaded.

A: If using UIUserNotificationActionContextMinimal then notification alert will display no more than 2 custom actions for this context. Docs
On 3D-touch-enabled devices, notification alert actions are available when pulling down the alert or using the 3d-touch gesture. The way you want to view custom actions is available for non 3d-touch devices.

redpajama_set_name: RedPajamaStackExchange


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Know You,Know Me!
Know You,Know Me! The World is Ours,You need Know it!
Google Co-Founders Plan To Sell Up To 10 Million Shares Over Next Five Years
Google co-founders Larry Page and Sergey Brin plan to steadily sell off up to 10 million shares of stock over the next five years, according to an SEC filing. At today's closing price of $550, those shares would be worth $5.5 billion if sold immediately. Although the two co-founders hold Class B shares with super-voting rights, if they sell all 5 million shares, their voting control will drop from 59 percent today to 48 percent. From the filing:
Google co-founders Larry Page and Sergey Brin plan to steadily sell off up to 10 million shares of stock over the next five years, according to an SEC filing. At today's closing price of $550, those shares would be worth $5.5 billion if sold immediately. Although the two co-founders hold Class B shares with super-voting rights, if they sell all 5 million shares, their voting control will drop from 59 percent today to 48 percent. From the filing:
Larry and Sergey currently hold approximately 57.7 million shares of Class B common stock, which represents approximately 18% of Google's outstanding capital stock and approximately 59% of the voting power of Google's outstanding capital stock. Under the terms of these Rule 10b5-1 trading plans, and as a part of a five year diversification plan, Larry and Sergey each intend to sell approximately 5 million shares. If Larry and Sergey complete all the planned sales under these Rule 10b5-1 trading plans, they would continue to collectively own approximately 47.7 million shares, which would represent approximately 15% of Google's outstanding capital stock and approximately 48% of the voting power of Google's outstanding capital stock (assuming no other sales and conversions of Google capital stock occur).
They would continue to be the largest shareholders, but would not be able to control the outcome of any shareholder vote as they do today. They, of course, could decide to stop selling just short of losing control. They also could probably find the other 2 percent of votes if they ever need it from CEO Eric Schmidt or a collection of other Google employees and loyal investors.
The two have not yet started selling shares under the plan, but it is common for tech founders to diversify their holdings in this manner. Bill Gates and Salesforce CEO Marc Benioff, for instance, sold stock of the companies they founded under similar plans. By selling at regular intervals, they get to cash out and diversify their holdings without spooking investors with sudden sales.
Original source : http://feedproxy.google.com/~r/Techcrunch/~3/bq65u...
发贴者 stu-g 时间: 3:34:00 PM
Twitter Looks To Help Bring Hope To Haiti With Hope140.org
Since the crisis in Haiti began, Twitter has played a big part in helping raise awareness of the tragedy. It's also helped charities and celebrities reach out to the community to encourage donations toward the Red Cross and the other organizations working hard to help the situation. Today, Twitter is launching a portal at Hope140.org for people looking to help Haiti, but who don't necessarily know where to start.
The site features a collection of recommended tweeters and Lists, including charities and people who are actually reporting from the field. A stream of recent tweets about the crisis is scrolling by in real time. And a large part of the page is dedicated to helping non-profits connect with the Twitter community, as a sort of best practices guide. It also calls out tonight's Hope For Haiti Now Telethon, which begins at 8 PM EST and is being hosted by George Clooney, Wyclef Jean, and Anderson Cooper.
Since the crisis in Haiti began, Twitter has played a big part in helping raise awareness of the tragedy. It's also helped charities and celebrities reach out to the community to encourage donations toward the Red Cross and the other organizations working hard to help the situation. Today, Twitter is launching a portal at Hope140.org for people looking to help Haiti, but who don't necessarily know where to start.
The site features a collection of recommended tweeters and Lists, including charities and people who are actually reporting from the field. A stream of recent tweets about the crisis is scrolling by in real time. And a large part of the page is dedicated to helping non-profits connect with the Twitter community, as a sort of best practices guide. It also calls out tonight's Hope For Haiti Now Telethon, which begins at 8 PM EST and is being hosted by George Clooney, Wyclef Jean, and Anderson Cooper.
Twitter's Biz Stone has also written a blog post about the efforts being made to help alleviate the crisis.
Here's a list of different ways to text to help Haiti. You can also do it through the iTunes Store.
Text HAITI to 90999 to donate $10 to the American Red Cross
Text QUAKE to 20222 to donate $10 to the Clinton Bush Haiti Fund
Text HABITAT to 25383 to donate $10 to Habitat For Humanity
Text OXFAM to 25383 to donate $10 to Oxfam A
Text HAITI to 25383 to donate $5 to International Rescue Committee
Text HAITI to 45678 to donate $5 to the Salvation Army in Canada
Text YELE to 501501 to donation $5 to Yele
Text RELIEF to 30644 to get automatically connected to Catholic Relief Services and donate money with your credit card
Text HAITI to 864833 to donate $5 to The United Way
Text CERF to 90999 to donate $5 to The United Nations Foundation
Text DISASTER to 90999 to donate $10 to Compassion International
Original source : http://feedproxy.google.com/~r/Techcrunch/~3/7LHVY...
Mobile Tech Developer Motricity Files For $250 Million IPO
Motricity, a Washington-based company that develops a software platform for mobile phones, has filed for an IPO of up to $250 million.
Motricity's core product is the 'mCore Platform', which offers a mobile search engine, storefront, and channels that allow carriers to deliver content to their customers. The company often acts as "the brand behind the brand" as it builds mobile software. Motricity's carrier clients include AT&T, Verizon, T-Mobile, Sprint, and Virgin Mobile. Enterprise clients include TBS, Showtime, Vogue, and Yahoo.
Motricity's core product is the 'mCore Platform', which offers a mobile search engine, storefront, and channels that allow carriers to deliver content to their customers. The company often acts as "the brand behind the brand" as it builds mobile software. Motricity's carrier clients include AT&T, Verizon, T-Mobile, Sprint, and Virgin Mobile. Enterprise clients include TBS, Showtime, Vogue, and Yahoo.
The company generated $88M in revenue in the first 9 months of 2009, but has not reached profitability. On its S-1 filed today, the company says its growth strategies include:
Focus our efforts on expanding the breadth of our solutions with industry leading participants, leveraging our strong relationships with the top five wireless carriers in the U.S.;
Expand our business into developed and emerging international markets, such as those in Southeast Asia, India and Latin America, by applying our expertise gained from the U.S. market and fully leveraging the capabilities and scale of the mCore platform;
Advance our technological leadership through the enhancement of the mCore platform, and the introduction of new solutions that increase the total value we provide to our carrier and enterprise customers;
Leverage our core competencies, technologies, and existing market position to broaden our offerings and customer base and advance into new market segments;
Gain additional scale and technology through opportunistic acquisitions that expand our total market opportunity, provide complementary technologies and solutions, and aid our international expansion efforts; and
Enhance our smartphone solutions to fully capitalize on the extensive capabilities of these devices and their significant market adoption.
Original source : http://feedproxy.google.com/~r/Techcrunch/~3/gwwwM...
The Apple Tablet Rumors The Other Blogs Are Afraid To Publish
CrunchGear is, as you know, the internet's primary nexus for trade secrets, corporation-breaking revelations, and the latest salacious home videos of tech CEOs (yes, Jen-Hsun Hwang, we have that one). Our power to elevate or crush giants in the industry is kept in check only by our unerring discretion — and by a set of laws, carved into amber slabs and venerated constantly in a hidden shrine deep beneath Mountain View.
But now and then our vast intelligence network brings in news of such inestimable importance that we must share it with our readers regardless what empires it may topple. Apple's event on the 27th is whipping the internet into a foaming frenzy, but I think you'll agree that the rumors so far have been pretty tame. 3G? Front-facing camera? Aluminum casing? You people underestimate Apple's dedication to bucking expectations. We've heard things that will curl your toes, and now, after much deliberation (and fortification of the shrine against the agents of Apple) we've decided to share some — not all — of these mind-blowing rumor-nuggets.
For instance, did you know that the Apple Tablet will not be constructed from aluminum, but from ostrich ivory?
Original source : http://feedproxy.google.com/~r/Techcrunch/~3/VQYjo...
Twitter's Revamped SUL Has Greatly Crippled The SUL Advantage
As you probably heard, yesterday, Twitter rolled out its revamped suggested users list (SUL). The list was a source of much controversy because those on it (including the @TechCrunch account) were assured to gain thousands of followers a day. And many of the accounts on it long enough had over a million followers. Obviously, many users not on it didn't consider this to be fair — while plenty of those on it also thought it was kind of BS. After all, if you're on it, and followed by a million people, any link you send out is likely to get many, many more clicks then by someone followed by a few hundred people. Even Twitter co-founder Evan Williams didn't like it. So Twitter made a change. And guess what? It worked.
While the numbers coming in are still very early (only based on one day), it appears that across the board, those who were on the SUL before and after the change are seeing dramatic drops in the numbers of users following them each day. In some cases, SUL users are even losing Twitter followers now following the change.
As you probably heard, yesterday, Twitter rolled out its revamped suggested users list (SUL). The list was a source of much controversy because those on it (including the @TechCrunch account) were assured to gain thousands of followers a day. And many of the accounts on it long enough had over a million followers. Obviously, many users not on it didn't consider this to be fair — while plenty of those on it also thought it was kind of BS. After all, if you're on it, and followed by a million people, any link you send out is likely to get many, many more clicks then by someone followed by a few hundred people. Even Twitter co-founder Evan Williams didn't like it. So Twitter made a change. And guess what? It worked.
While plenty were quick to note that the new SUL is more or less the same as the old SUL, just broken into categories, there is one vital difference: there is no way to add all the users on the lists with one click. This means that you now have to go through each user on the list one-by-one to add them, which most people apparently don't feel the need to do.
I pulled these interesting new numbers are pulled from the site TwitterCounter. For example, the TechCrunch account (which again was on the SUL before and also is currently) went from gaining 2,979 followers a day on average, all the way down to gaining just 286 yesterday (and it's actually a bigger drop because the 286 number pulled down the 3,112 average that stood yesterday when I checked expecting there to be a huge drop). Another SUL mainstay, Twitter creator Jack Dorsey, went from gaining 2,184 followers a day to losing 162 yesterday. Same with Twitter angel investor Chris Sacca who went from gaining 2,892 a day to losing 68 yesterday. The main Google Twitter account went from gaining 4,908 followers a day on average to 893 yesterday. I could go on, but you get the point.
To be clear, the new SUL is still helping those that weren't on it previously gain more followers. For example, Scott Beale's LaughingSquid account wasn't on the old SUL but is on the new one, and went from gaining about 51 users a day to gaining 151 users a day. But that's a far cry from gaining 2,000 – 3,000 new followers every day.
Everyone will probably agree this new method is a much more fair and balanced way to help users find interesting people on Twitter. That said, those who were on the SUL before are now likely out of reach of anyone not on it previously. Well, unless you're @billgates, who apparently doesn't need the SUL to attract the masses.
Update: Twitter's Doug Bowman has responded to this post in a tweet saying, "Exactly, and it was completely intentional."
[photo: flickr/hape gera]
Original source : http://feedproxy.google.com/~r/Techcrunch/~3/tZ7RQ...
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Kids and Allergies
Sometimes, bayonetting tradition is the smart thing to do
Submitted by on Sunday, 31 January 2010 No Comment
Bayonets – he calls them "knife guns" – crack Big Guy up.
"Why are they using those?" he asked recently as we watched one of the "Pirates of the Caribbean. "Why don't they just use their guns?"
Back then, guns weren't as powerful and sometimes you had to stab the bad guys if you couldn't get off a good shot. Daddy learned how to use one in basic training, I said.
"Why?" Big Guy asked.
That's what I'd wondered, too. Though bayonets still are used occasionally as a last resort – and as recently as two years ago a British officer was awarded a medal after he used his in a battle in Afghanistan – most American weapons no longer can handle bayonets.
It turns out that the Army has been wondering as well and now is considering dropping what arguably is more traditional than useful.
"Bayonet training – something that's been a staple in our Army – is kind of hard to teach right now when most of the weapons we use don't have the ability to affix a bayonet," Lt. Gen. Mark Hertling said recently. "So why are we training it? We're changing the way we train fighting with a rifle, and that's how we're couching it now, as opposed to bayonet training."
Hertling says the Army's entire basic training program will be rewritten to reflect that and other changes. Changes such as moving away from teaching wrestling to focusing more on martial arts. Changes that will account for the fact that more of today's recruits are in worse physical condition than those a generation earlier.
The revisions make sense, especially in a day when soldiers can wind up in combat mere months after they finish training.
And if the military can look hard enough at itself to figure out that it's doing things that no longer make sense, it should be easy for any business or organization to do so as well.
I worked for a company once that did zero-base budgeting – the theory was that everything had to be justified anew every year. The reality was, the zero base was an excuse to slash spending every year, regardless of whether the money really was needed or not.
But rarely does anyone do zero-based workflow, analyzing whether tasks still were justified. If they do, they'll find far more waste than they've ever unearthed while looking for money spent inefficiently.
A lot of us in many walks of live can learn from Hertling's work. If the Army can end bayonet training after all these centuries, what can we find in our worlds that simply no longer makes sense?
Copyright 2010 Debra Legg. All rights reserved.
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Security researchers of F-Secure have discovered a flaw with nearly all modern computers that allow potential hackers to steal sensitive information from your locked devices.
As reported by TechCrunch, the firmware exploit has to do with how almost all Mac and Windows machines overwrite data when they are turned off. This exploit is based on a cold boot attack, where hackers are working to steal data from a computer that's powered off.
The researchers previously shared their discovery with Apple, Microsoft and Intel. Macs with the new T2 chip are immune from the flaw, which include the iMac Pro and the 2018 MacBook Pros.
"This technique requires physical access. To protect sensitive info, at a minimum, we recommend using a device with a discreet Trusted Platform Module (TPM), disabling sleep/hibernation and configuring BitLocker with a Personal Identification Number (PIN)," Jeff Jones, a senior director at Microsoft, said in a statement.


text:
Remy Cabella only needs to check the history books to see if he'd be 'bored' in Newcastle
Montpellier president has attempted to deter Remy Cabella from making the switch to Tyneside and claimed that the 23-year-old would be: "Bored s***less in Newcastle"
Lee RyderChief Newcastle United Writer
Remy Cabella
What on earth have Newcastle United done to upset Louis Nicollin?
The barmy Montpellier president has attempted to deter his young star Remy Cabella from making the switch to Tyneside and claimed that the 23-year-old would be: "Bored s***less in Newcastle."
The Montpellier president, famed for dying his hair orange and blue in the club's colours, added: "Personally, I wouldn't go there. Remy, I think, deserves something different than Newcastle."
Unfortunately, despite Nicollin's derogatory take on life in the Toon, history is not on his side when it comes to players from far and wide enjoying the Geordie lifestyle.
From George and Ted Robledo in the FA Cup-winning teams of the 1950s to United's great Dane Benny Arentoft, who won the Fairs Cup in 1969, to Mirandinha in the 80s then the host of foreign stars that came to Newcastle during the Premier League era. However, it isn't just overseas stars who fall in love with Newcastle after pulling on the black and white shirt.
Toon legend Bob Moncur and former captain Mick Martin still live here years after retirement, while French defender Olivier Bernard, who also still resides on Tyneside, even bought a non-league football club in the region!
When Mirandinha became the first Brazilian to play in England he quickly fell in love with the place.
He said: "I love the club and the city of Newcastle, and I left behind a lot of friends there.
"They've always treated me really well and the fans always give me a very warm welcome.
"They still call me Mira, just like they did when I was playing. That's special."
Philippe Albert came from Belgium in 1994 and never looked back.
He loved the Quayside and worked hard for the team and played hard.
Albert said: "Whenever I come back I always feel a special tingle down the spine. It's a very special place.
"The only advice you can give them (players coming in from abroad) is give everything for the club and you will get it back in more ways than one.
"The fans are magnificent. If they give their all, they will see the rewards, not just in the stadium, but around the city."
Tino Asprilla is another star who came into the unknown but quickly learned to love the area. The Colombian had enjoyed success in Italy but arrived in Newcastle amid a snow storm wearing a fur coat.
But he still visits the city on a yearly basis and loves his trips back to St James' Park.
He said: "We loved it when we played. We used to love going out to celebrate winning games and we used to see the fans all of the time.
"They were great times."
Nobby Solano came in from Peru and also loved the life on Tyneside, so much so he is another regular visitor to the city.
The trumpet-playing star wasn't the only one.
David Ginola came in from swanky Paris in 1995 and said: "Newcastle is an amazing place and not like anywhere else in the country. When I signed for the club it was a shock, it was a huge difference
"In one of my first games I had a cigarette on the bus after we beat Sheff Wed.
"The players shouted 'Gaffer, gaffer David is smoking'. Then we stopped off and had fish and chips with lots of grease eating it from a newspaper."
Newcastle's current foreign legion are also enjoying it on Tyneside.
Italian full-back Davide Santon arrived with family members to support him but met a Geordie girl and the rest is history.
"I have my family here now," he says. I love Newcastle and the fans are always fantastic.
"I became a father on May 21. It was the best day of my life. It has been an amazing summer for me.
"I have spent it with my little daughter and girlfriend. My girlfriend helped me a lot here.
"It helps on the pitch too.
"When you are relaxed in your home life it makes such a difference."
Therefore Remy Cabella should head to the history books, not his president's office if he wants advice on how it could pan out for him if he makes the move to Newcastle.
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